Lester Adaptation of Cardio Metabolic Measurements: An Inpatient Interventional Framework for Women with Mental Illness

Abstract

Aims of the study: To assess the prevalence of metabolic syndrome and implement a framework for screening and management of cardio metabolic risks in women on psychiatric in-patient wards. Background: An estimated 29-48% of psychiatric in-patients have metabolic syndrome. Severe mood disorders and psychotic illnesses are independent risk factors. 20-25% of the world’s adult population have metabolic syndrome and they are twice as likely to die from and three times as likely to have a heart attack or stroke compared with people without the syndrome. This study gives an overview of the application of Lester Tool on busy in-patient units and interventional approaches adapted by the team. Method: 46 admissions between April to July 2015 were included in Phase 1. Information on physical health medication and menopausal status was recorded in addition to metabolic syndrome parameters. Data on 47 admissions in Phase 2 between March to May 2016 was obtained. Advice on healthy lifestyle, diet, medication and smoking cessation was offered as routine. Results: Phase 1: Of the total 46 patients, 38 (82.60%) were on antipsychotics, 6 (13.04%) had metabolic syndrome and 14 (30.43%) did not and data was not available on 26 (56.52%). Most frequently missing criteria were waist circumference and triglyceride measurements. Phase 2: Of the total 45 patients, 14 (31.1%) had metabolic syndrome, 12 (26.6%) did not and data was unknown in 13 (28.8%). 2/3rd of admissions were compliant with investigations, as opposed to 1/3rd in Phase 1. 86.6% compliance was achieved in BMI checks. 20% were prescribed anti-hypertensive or anti-diabetic medication during admission and were referred to the dietician and diabetes clinic. Conclusion: Clinical identification and management of metabolic syndrome is essential and preventative measures by referral to specialist services or use of 3DFD model could be implemented. Lester Adaptation has been an effective tool for recording cardio metabolic risks; but in reality an effective interventional process could prove hard to achieve in mental health settings.